Opioid prescribing continues on a downward trend, but some areas show an increase in chronic use.
SEATTLE, WA-The Washington Health Alliance (Alliance) issues its 15th Community Checkup report today with results for more than 2,300 unique entities; clinics, medical groups, hospitals, and health plans, and continues its long tradition of providing transparency on the state’s health care system (download the pdf here). “There is no doubt that the COVID-19 pandemic has profoundly changed our health care system with an increase in access to telehealth and other remote treatments, and at the same time, it has illuminated access and other challenges faced by the underserved populations that have been disproportionally affected,” says Alliance Executive Director Nancy Giunto. “With that in mind, the Alliance issues this Community Checkup to provide the information we need to make changes to improve the quality and affordability of health care delivered to all Washingtonians.”
Included in this release are results for more than 100 performance measures, including all 63 measures from the Common Measure Set, created by legislation in 2014 and used to track the state’s progress in priority areas, including access, prevention, acute care, and chronic care. Using medical claims data from January 1, 2019 to December 31, 2019, the Alliance ranks clinics, medical groups, counties, and Accountable Communities of Health (ACHs) with its signature ranking formula, the Quality Composite Score, compiling performance on up to 29 measures considered strong indicators of quality primary care. The Community Checkup Highlight on Quality Composite Scores reports these medical groups as the top performers in the state:
|The Polyclinic||International Community Health Services|
|Kaiser Permanente Washington||Yakima Valley Farm Workers Clinic|
|Virginia Mason Medical Center||Columbia Medical Associates|
|University of Washington Medical Center||University of Washington Medical Center|
|Association of University Physicians, DBA||Family Care Network|
There are some encouraging trends in statewide opioid prescribing practices, according to the Community Checkup Highlight on Opioid Prescribing Practices. Using data from the Washington State Department of Health Prescription Monitoring Project from Q4 2018 to Q3 2020, there were steady decreases in the average number of days for a first prescription of opioids and the number of high dosages prescribed (>50 MME/day and >90 MME/day). Despite overall improvement at the state level, the number of patients transitioning to long-term opioid use (receiving more than a 60-day supply) began increasing in several counties in Q1 2020 and has continued on an upward trend through Q3 2020. This is concerning in light of a recent Centers for Disease Control (CDC) report that the 2020 data on opioid death rates suggests “an acceleration of overdose deaths during the pandemic.” Health policy leaders are calling for heightened attention to this topic, as there is concern that the spillover effects of the pandemic related to the stress of job loss, illness, isolation, or the loss of loved ones, have created a dangerous situation for those who struggle with substance abuse disorders.
In terms of overall quality, Washington state shows little improvement compared to national performance based on the Healthcare Effectiveness Data and Information Set (HEDIS) dataset published by the National Committee for Quality Assurance (NCQA), one of the nation’s most widely used health care tools for measuring health care quality. Alliance members continue their strong commitment to the goal of statewide performance at the 90th percentile nationally, but the state continues to show performance far below that on all but a small number of HEDIS measures. The Community Checkup Highlight on Variation in Health Care Quality shows how the quality of care can vary greatly by type of insurance, provider, and geographic area.
The rate at which diabetic patients receive recommended eye exams is a measure that illustrates what can be dramatic differences in the quality of care based on insurance type or location. For example, those with commercial insurance receive this recommended service 64% of the time, but the rate is just 47% for those covered by Medicaid. “This runs counter to the national data which suggest that those with Medicaid typically receive eye exams at higher rates than those with commercial coverage,” says Alliance Director of Performance Improvement and Innovation Karen Johnson. “Unfortunately, we do not achieve our stated goal of the national 90th percentile for either insurance type—68% for commercial and 70% for Medicaid. However, we know there are some medical groups and clinics where more than 90% of their diabetic patients are receiving this important preventive care. By identifying those who are leading the way, the Alliance is encouraging that success to be replicated.”
Practical advice on how to use Community Checkup results to help health care professionals, plans, and purchasers evaluate and improve the quality of care is highlighted in this release. Michele Ritala, King County Benefits Strategic Planner says, “The Alliance’s information is great in terms of informing us on how we’re doing with respect to preventive and chronic care measures, such as which medical groups, provider groups, and health plans are better at coordinating the care received by our employees and their families.” Ritala says their communications efforts, including using the Alliance’s consumer-friendly website Own Your Health, has resulted in “a significant increase” in the number of people who have a primary care provider and who are able to access those important health care services.
The Community Checkup Highlight on Health Care Spending in Washington State reports on 2014 to 2019 state health care spending as a percentage of the state’s gross domestic product (GDP), Medicaid, and public employee and retiree expenditures. Highlight on Health Care Spending Washington StateUsing data provided by the Washington State Health Care Authority, Medicaid spending increased 25% per enrollee and for public employees and retirees it increased 21% per enrollee. After several years of increases, the percentage of spending as a percentage of GDP leveled out in 2017, and started a downward trend, reducing 4% in 2018 and 2% in 2019.
About the Washington Health Alliance
The Washington Health Alliance (Alliance) is a 501(c)(3) nonprofit nonpartisan organization working collaboratively to transform Washington state’s health care system for the better. The Alliance brings together more than 185 committed member organizations to improve health and health care by offering a forum for critical conversation and aligned efforts by health plans, employers, union trusts, hospitals and hospital systems, health care professionals, start-up companies, consultants, consumers, and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on health care quality, value, pricing, and overall spending. The Alliance publishes its reports at WACommunityCheckup.org and provides guidance for consumers at OwnYourHealthWA.org so that individuals can make informed health care decisions.
Date: March 10, 2021
Contact: Leslie Bennett